Smart Practice: Maintain as much metatarsal length as you reasonably can when performing isolated first ray amputations in patients with diabetes.
What’s the Claim?
A large case series of patients with diabetes undergoing first ray amputations found:
- After controlling for relevant confounding variables, isolated first metatarsal amputations that maintained >1/3 of the length of the ray were associated with lower odds of transfer amputations of the lesser toes compared with shorter remaining ray length at the index amputation
- About 2/3 of patients undergoing first ray amputations were readmitted and about 10% had a revision amputation (and based on the study’s design, the actual risk of this probably was much higher)
- Nearly 1/3 of these patients died at a mean of 3 ± 2 years